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What is a cystocele?

A cystocele, also called a prolapsed or dropped bladder, is the bulging or dropping of the bladder into the vagina. The bladder, located in the pelvis between the pelvic bones, is a hollow, muscular, balloon-shaped organ that expands as it fills with urine. During urination, also called voiding, the bladder empties through the urethra, located at the bottom of the bladder. The urethra is the tube that carries urine outside of the body. The vagina is the tube in a woman’s body that runs beside the urethra and connects the womb, or uterus, to the outside of the body.

What causes a cystocele?

A cystocele occurs when the muscles and supportive tissues between a woman’s bladder and vagina weaken and stretch, letting the bladder sag from its normal position and bulge into the vagina or through the vaginal opening. In a cystocele, the bladder tissue remains covered by the vaginal skin. A cystocele may result from damage to the muscles and tissues that hold the pelvic organs up inside the pelvis. A woman’s pelvic organs include the vagina, cervix, uterus, bladder, urethra, and small intestine. Damage to or weakening of the pelvic muscles and supportive tissues may occur after vaginal childbirth and with conditions that repeatedly strain or increase pressure in the pelvic area, such as

repetitive straining for bowel
movements

constipation

chronic or violent coughing

heavy lifting

being overweight or obese

Normal bladder position

Cystocele

A woman’s chances of developing a
cystocele increase with age, possibly because
of weakening muscles and supportive tissues
from aging. Whether menopause increases
a woman’s chances of developing a cystocele
is unclear.

Women who have a cystocele may also leak
some urine as a result of movements that
put pressure on the bladder, called stress
urinary incontinence. These movements
can include coughing, sneezing, laughing, or
physical activity, such as walking. Urinary
retention––the inability to empty the
bladder completely––may occur with more
severe cystoceles if the cystocele creates
a kink in the woman’s urethra and blocks
urine flow.

How is a cystocele diagnosed?

Diagnosing a cystocele requires medical
tests and a physical exam of the vagina.
Medical tests take place in a health care
provider’s office, an outpatient center, or a
hospital. The health care provider will ask
about symptoms and medical history. A
health care provider uses a grading system
to determine the severity of a woman’s
cystocele. A cystocele receives one of three
grades depending on how far a woman’s
bladder has dropped into her vagina:

grade 1—mild, when the bladder drops
only a short way into the vagina

grade 2—moderate, when the bladder
drops far enough to reach the opening
of the vagina

grade 3—most advanced, when the
bladder bulges out through the opening
of the vagina

If a woman has difficulty emptying her
bladder, a health care provider may measure
the amount of urine left in the woman’s
bladder after she urinates. The remaining
urine is called the postvoid residual. A
health care provider can measure postvoid
residual with a bladder ultrasound. A
bladder ultrasound uses a device, called a
transducer, that bounces safe, painless sound
waves off the bladder to create an image
and show the amount of remaining urine.
A specially trained technician performs the
procedure, and a radiologist—a doctor who
specializes in medical imaging—interprets
the images. A woman does not need
anesthesia.

A health care provider can also use a
catheter—a thin, flexible tube—to measure a
woman’s postvoid residual. The health care
provider inserts the catheter through the
woman’s urethra into her bladder to remove
and measure the amount of remaining urine
after the woman has urinated. A postvoid
residual of 100 mL or more is a sign that
the woman is not completely emptying her
bladder. A woman receives local anesthesia.

A health care provider may use a voiding
cystourethrogram—an x-ray exam of the
bladder—to diagnose a cystocele as well.
A woman gets a voiding cystourethrogram
while urinating. The x-ray images show
the shape of the woman’s bladder and let
the health care provider see any problems
that might block normal urine flow. An
x-ray technician performs a voiding
cystourethrogram, and a radiologist
interprets the images. A woman does not
need anesthesia; however, some women
may receive sedation. A health care
provider may order additional tests to rule
out problems in other parts of a woman’s
urinary tract.

How is a cystocele treated?

Cystocele treatment depends on the severity
of the cystocele and whether a woman has
symptoms. If a woman’s cystocele does
not bother her, a health care provider
may recommend only that she avoid heavy
lifting or straining, which could worsen her
cystocele. If a woman has symptoms that
bother her and wants treatment, the health
care provider may recommend pelvic muscle
exercises, a vaginal pessary, or surgery.

A vaginal pessary is a small, silicone medical
device placed in the vagina that supports
the vaginal wall and holds the bladder in
place. Pessaries come in a number of shapes
and sizes. A health care provider has many
options to choose from to find the most
comfortable pessary for a woman.

Pessary device

Pessary inserted in the vagina

A heath care provider may recommend
surgery to repair the vaginal wall support
and reposition the woman’s bladder to
its normal position. The most common
cystocele repair is an anterior vaginal
repair—or anterior colporrhaphy. The
surgeon makes an incision in the wall of
the woman’s vagina and repairs the defect
by folding over and sewing together extra
supportive tissue between the vagina and
bladder. The repair tightens the layers of
tissue that separate the organs, creating
more support for the bladder. A surgeon
who specializes in the urinary tract or
female reproductive system performs an
anterior vaginal repair in a hospital. The
woman receives either regional or general
anesthesia. The woman may stay overnight
in the hospital, and full recovery may take up
to 4 to 6 weeks.

Eating, Diet, and Nutrition

Points to Remember

A cystocele, also called a prolapsed
or dropped bladder, is the bulging
or dropping of the bladder into the
vagina.

A cystocele occurs when the
muscles and supportive tissues
between a woman’s bladder and
vagina weaken and stretch, letting
the bladder sag from its normal
position and bulge into the vagina
or through the vaginal opening.

Diagnosing a cystocele requires
medical tests and a physical exam
of the vagina.

Cystocele treatment depends on
the severity of the cystocele and
whether a woman has symptoms.

Hope through Research

The National Institute of Diabetes and
Digestive and Kidney Diseases (NIDDK)
conducts and supports a variety of research
in kidney diseases and urinary tract
disorders. The knowledge gained from these
studies is advancing scientific understanding
of why kidney diseases and urinary tract
disorders develop and is leading to improved
methods of diagnosing, treating, and
preventing them.

Clinical trials are research studies involving
people. Clinical trials look at safe and
effective new ways to prevent, detect, or
treat disease. Researchers also use clinical
trials to look at other aspects of care, such
as improving the quality of life for people
with chronic illnesses. To learn more about
clinical trials, why they matter, and how to
participate, visit the NIH Clinical Research
Trials and You website at www.nih.gov/health/clinicaltrials. For information about current
studies, visit www.ClinicalTrials.gov.

Acknowledgments

Publications produced by the Clearinghouse
are carefully reviewed by both NIDDK
scientists and outside experts. This
publication was reviewed by Catherine S.
Bradley, M.D., M.S.C.E., University of Iowa
Carver College of Medicine.

You may also find additional information about this topic by visiting MedlinePlus at www.medlineplus.gov.

This publication may contain information about medications and, when taken as prescribed, the conditions they treat. When prepared, this publication included the most current information available. For updates or for questions about any medications, contact the U.S. Food and Drug Administration toll-free at 1–888–INFO–FDA (1–888–463–6332) or visit www.fda.gov. Consult your health care provider for more information.

National Kidney and Urologic Diseases Information Clearinghouse

The National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health of the U.S. Department of Health and Human Services. Established in 1987, the Clearinghouse provides information about diseases of the kidneys and urologic system to people with kidney and urologic disorders and to their families, health care professionals, and the public. The NKUDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about kidney and urologic diseases.

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